Provider Demographics
NPI:1689702243
Name:MCGILL, MARY JANE (LCMHC-S, LCAS, CCS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LCMHC-S, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20815 STERLING BAY LN E APT K
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4915
Mailing Address - Country:US
Mailing Address - Phone:336-541-5867
Mailing Address - Fax:
Practice Address - Street 1:16930 W CATAWBA AVE APT K
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5638
Practice Address - Country:US
Practice Address - Phone:336-541-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS5125101YM0800X
NC52101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103046Medicaid
NC6103046Medicaid